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The findings of the report into Blackpool Victoria hospital are as shocking as they are damning: a culture of bullying, racial discrimination and harassment that has contributed to a staff exodus with a direct impact on patients. The treatment of chronic disease, including Parkinson’s, were just some of the areas blighted by what appears to be a toxic culture.
But the Royal College of Physicians report, leaked to the Guardian, exposes much broader challenges for the NHS – and particularly for hospitals in the most deprived corners of Britain.
Clinicians in places such as Blackpool are overwhelmed by generational ill health and entrenched poverty, a crisis that is deepening in many parts of the country. Their ability to respond is often hampered by their struggle to attract the best staff.
The issues are complex. Hospitals in poorer areas are flooded with people suffering chronic health problems, including higher rates of depression, chronic obstructive pulmonary disease (COPD) and other respiratory conditions worsened by living in damp homes.
The worst performing NHS trusts in the league table broadly tally with levels of deprivation.
Blackpool Teaching Hospitals NHS Foundation Trust, and University Hospitals Birmingham NHS Foundation Trust were in the 10 worst performing trusts, with Hull University Teaching Hospitals NHS Trust in 11th place from bottom.
In the 2025 indices of multiple deprivation, seven neighbourhoods in Blackpool ranked among the top 10 most deprived in England, while Kingston upon Hull and Birmingham were among the local authorities with the highest proportions of neighbourhoods among the most deprived in England.
The problem is exacerbated by inequalities in primary care. The current formula for distributing GP funding, known as the Carr-Hill formula, uses expected workload of GP practices to determine distribution of funding, but it is based on outdated figures and has left people in deprived areas and coastal towns with the fewest GPs.
A study last year by the Royal College of General Practitioners found that GPs in deprived areas are responsible for a staggering 2,450 patients each on average, 300 more than in affluent areas of England. When patients struggle to get a GP appointment, they often end up in A&E.
“People who have choices who are affluent want to live in affluent areas so won’t necessarily choose to move to the places in need,” said one NHS manager.
Another in north-west England said poverty was having a “massive impact” on the quality of healthcare: “We can’t seem to attract GPs into our population, we’ve got a lot of homegrown GPs, so we’re quite understaffed per head of population which can have issues on [patient] access and other things.”
Researchers from Lancaster University also found that hospital facilities and resources, geographical location, and reputation all played a role in the recruitment and retention of medics.
Last year the UKFPO (UK Foundation Programme) introduced a new system for allocating newly qualified doctors, which was previously based on academic achievement and further study.
Under the new system, applicants are instead given a random number, which is used to determine where they will spend the first two years of their medical careers. With more demand for places at the best hospitals, and those in big cities, the new system, although not without its critics, has made it more unlikely that the brightest and best new doctors will never end up at the worst-performing hospitals.
There is also an income stream issue; research published in the BMJ found that hospitals serving more deprived populations struggle to generate private income.
Researchers found an “uneven distribution” of income from private patients and charitable donations across NHS trusts, which was linked to deprivation levels.
Wes Streeting, the health secretary, is leading what he called the biggest NHS transformation plan in a generation in an effort to move care away from struggling hospitals and into communities – and from treatment to prevention.
But the challenge is stark. Britain has the lowest life expectancy in western Europe and one of the highest tallies among rich countries for preventable deaths. NHS bodies in the regions have been ordered to slash their budgets in half, cutting as many as 13,500 jobs, leaving senior figures alarmed about how this squares with Streeting’s focus on community care.
One NHS manager, who did not want to be named, welcomed the government’s “real focus” on addressing health inequalities but said questions remained about whether more deprived areas of the country would see more funding. Another described the cuts as “brutal”.
